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Abstract
Hemoglobin E (HbE) is an extremely common structural hemoglobin variant that occurs at high frequencies throughout many Asian countries. It is a β-hemoglobin variant, which is produced at a slightly reduced rate and hence has the phenotype of a mild form of β thalassemia. Its interactions with different forms of α thalassemia result in a wide variety of clinical disorders, whereas its coinheritance with β thalassemia, a condition called hemoglobin E β thalassemia, is by far the most common severe form of β thalassemia in Asia and, globally, comprises approximately 50% of the clinically severe β-thalassemia disorders.
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Affiliation(s)
- Suthat Fucharoen
- Thalassemia Research Centre, Institute of Science and Technology for Research and Development, Mahidol University, Bangkok, Thailand.
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Cavdar AO, Arcasoy A. Hb D punjab--alpha thalassaemia combination in a Turkish family. SCANDINAVIAN JOURNAL OF HAEMATOLOGY 2009; 13:313-9. [PMID: 4445829 DOI: 10.1111/j.1600-0609.1974.tb00275.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Laosombat V, Viprakasit V, Chotsampancharoen T, Wongchanchailert M, Khodchawan S, Chinchang W, Sattayasevana B. Clinical features and molecular analysis in Thai patients with HbH disease. Ann Hematol 2009; 88:1185-92. [DOI: 10.1007/s00277-009-0743-5] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Accepted: 04/01/2009] [Indexed: 11/28/2022]
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Sanchaisuriya K, Chirakul S, Srivorakun H, Fucharoen G, Fucharoen S, Changtrakul Y, Sanchaisuriya P. Effective screening for double heterozygosity of Hb E/α0-thalassemia. Ann Hematol 2008; 87:911-4. [DOI: 10.1007/s00277-008-0520-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2007] [Accepted: 05/29/2008] [Indexed: 11/29/2022]
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Kishore B, Khare P, Gupta RJ, Bisht S, Majumdar K. Hemoglobin E disease in North Indian population: a report of 11 cases. ACTA ACUST UNITED AC 2007; 12:343-7. [PMID: 17654063 DOI: 10.1080/10245330701255247] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Hemoglobin E (beta26Glu --> Lys) is the most common hemoglobin (Hb) variant in Southeast Asia and the second most prevalent worldwide. However in India, it is prevalent in Bengal and the north-eastern region, but relatively rare in the rest of the country. Identification of this Hb variant is important, because the doubly heterozygous state for HbE and beta-thalassemia is characterized clinically by thalassemia major, a situation different from other compound heterozygous states for structural beta-chain variants and beta-thalassemia. Thus, the affected individual may be symptomatic and transfusion dependent at an early age. This paper reports four cases with Hb E trait, three cases with hemoglobin E disease and another four cases with Ebeta-thalassemia. Laboratory investigations are based on RBC indices and high performance liquid chromatography (HPLC). A negative correlation has been found to exist between levels of HbA(2) and RBC indices including the MCV and MCH. A similar correlation has been seen between levels of HbF with Hb, RBC count, and MCV. The main aim is to increase the awareness of this relatively rare disorder, so that it can be included in the differential diagnosis of patients presenting clinically like thalassemia intermedia or thalassemia major. This awareness may also help in prenatal diagnosis, genetic counseling and clinical management. The clinical, hematological and laboratory features of this disorder are also discussed.
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Affiliation(s)
- Bimal Kishore
- Department of Clinical Pathology, Lok Nayak Hospital, New Delhi, India
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Abstract
AE-Bart's disease is a thalassemia intermedia resulting from the interaction between alpha-thalassemia and heterozygous Hb E. In this study we analyzed the alpha-globin genes of 25 patients designated as AE-Bart's disease by starch gel electrophoresis. Twenty-one cases had Hb Constant Spring in addition to Hbs E + A + Bart's, and the remaining four cases had only Hbs E + A + Bart's. DNA mapping revealed the alpha-globin genotype of alpha-thalassemia-1/alpha-thalassemia-2 in four patients who had Hbs E + A + Bart's, whereas the alpha genotype of the remainder is alpha-thalassemia-1/nondeletion alpha-thalassemia. The nondeletion alpha-thalassemia is Hb Constant Spring as indicated by starch gel electrophoresis. Hematologic data and hemoglobin analysis showed that Constant Spring-AE-Bart's disease is a more severe clinical syndrome than AE-Bart's disease.
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Affiliation(s)
- V Thonglairuam
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
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Fucharoen S, Winichagoon P, Thonglairuam V, Wasi P. EF Bart's disease: interaction of the abnormal alpha- and beta-globin genes. Eur J Haematol 1988; 40:75-8. [PMID: 3342862 DOI: 10.1111/j.1600-0609.1988.tb00800.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
EF Bart's disease is an uncommon form of thalassaemia intermedia resulting from the co-inheritance of alpha-thalassaemia and haemoglobin E in the same subject. Starch-gel electrophoresis revealed two phenotypes in 19 patients with EF Bart's. 16 patients had Hbs CS + E + F + Bart's and the remainder had Hbs E + F + Bart's. DNA mapping and haemoglobin electrophoresis indicated that there are four genotypes, involving 5 abnormal globin genes, responsible for this thalassaemia syndrome.
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Affiliation(s)
- S Fucharoen
- Faculty of Graduate Studies, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Kleman K, Lubin B, Wilson JB, Kutlar A, Webber BB, Huisman TH. Hb F-Oakland or alpha 2G gamma I2(26)(B8)Glu----Lys. Hemoglobin 1987; 11:181-3. [PMID: 2442122 DOI: 10.3109/03630268709005796] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Trent RJ, Harris MG, Fleming PJ, Wyatt K, Hughes WG, Kronenberg H. Haemoglobin D Punjab. Interaction with alpha thalassaemia and diagnosis by gene mapping. SCANDINAVIAN JOURNAL OF HAEMATOLOGY 1984; 32:275-82. [PMID: 6322284 DOI: 10.1111/j.1600-0609.1984.tb01693.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
A family which illustrates the inheritance of Hb D Punjab (a beta globin chain variant) and alpha thalassaemia is described. Interaction between Hb D Punjab and alpha thalassaemia is observed since levels of Hb D vary according to the number of alpha globin genes deleted. The technique of gene mapping has been utilised in the current study to provide definitive evidence of alpha thalassaemia and also demonstrates a novel way to identify Hb D Punjab.
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Cunningham TM. Hemoglobin E in Indochinese refugees. West J Med 1982; 137:186-90. [PMID: 7147932 PMCID: PMC1274062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Hemoglobin E, a beta-chain variant commonly found in Southeast Asian populations, is relatively unfamiliar to American physicians. The hematologic features of 55 patients with hemoglobin E (8 homozygote, 46 heterozygote and 1 genotype E/beta(thal)) are described and compared with previous series. The patients were immigrants from Cambodia, Laos, Thailand and Vietnam. These studies support the association of this beta-globin variant with microcythemia and suggest that it mimics the "thalassemia picture" of microcythemia out of proportion to the degree of anemia. Splenomegaly was not a characteristic. Oxidative hemolysis may occur under conditions that deplete reduced glutathione. The simultaneous presence of the beta-thalassemia trait appears to significantly worsen the prognosis.
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Matthay KK, Mentzer WC, Dozy AM, Kan YW, Bainton DF. Modification of hemoglobin H disease by sickle trait. J Clin Invest 1979; 64:1024-32. [PMID: 479366 PMCID: PMC372212 DOI: 10.1172/jci109539] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The rarity of hemoglobin (Hb) H disease in combination with sickle trait may be due in part to the absence of actual Hb H in individuals who, nonetheless, have inherited the deletion of three alpha-globin genes. We describe here a boy with persistent microcytic, hypochromic anemia despite adequate iron stores, who exhibited splenomegaly with a normal reticulocyte count and only rare inclusions in circulating erythrocytes. Starch gel electrophoresis and isoelectric focusing at age 5 yr showed 21% Hb S, persistent Hb Bart's, but no Hb H. Recticulocyte alpha/non-alpha globin chain synthesis ratio was 0.58 at age 5. The mother (Asian) had laboratory evidence of alpha-thalassemia trait and the father (Black) had sickle trait. The nature of alpha-thalassemia in this patient was investigated both by liquid hybridization and by the Southern method of gene mapping, in which DNA is digested with restriction endonucleases and the DNA fragments that contained the alpha-globin structural gene identified by hybridization with complementary DNA. The patient had only one alpha-globin structural gene, located in a DNA fragment shorter than that found in normal or alpha-thalassemia trait individuals, but similar to that present in other patients with Hb H disease. Morphologic studies of bone marrow by light and electron microscopy revealed erythroid hyperplasia with inclusions in polychromatic and orthochromatic erythroblasts, suggesting early precipitation of an unstable hemoglobin. The lack of demonstrable Hb H may be the result of both diminished amounts of beta(A) available for Hb H formation (since one beta-globin gene is beta(S)) and the greater affinity of alpha-chains for beta(A) than beta(S)-globin chains leading to the formation of relatively more Hb A than Hb S. The presence of a beta(S) gene may thus modify the usual clinical expression of Hb H disease.
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Abstract
The current concepts of alpha-thalassemia including incidence, genetics, clinical spectrum and diagnosis are reviewed. Speculation concerning clinical application of the molecular biology of alpha-thalassemia is also presented.
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DeSimone J, Kleve L, Longley MA, Shaeffer J. Unbalanced globin chain synthesis in reticulocytes of sickle cell trait individuals with low concentrations of hemoglobin S. Biochem Biophys Res Commun 1974; 59:564-9. [PMID: 4855313 DOI: 10.1016/s0006-291x(74)80017-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Reed RE, Winter WP, Rucknagel DL. Haemoglobin inkster (alpha2 85aspartic acid leads to valine beta2) coexisting with beta-thalassaemia in a Caucasian family. Br J Haematol 1974; 26:475-84. [PMID: 4212045 DOI: 10.1111/j.1365-2141.1974.tb00489.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Wasi P, Na-Nakorn S, Pootrakul P, Panich V. Incidence of haemoglobin Thai: a re-examination of the genetics of alpha-thalassaemic diseases. Ann Hum Genet 1972; 35:467-70. [PMID: 4672504 DOI: 10.1111/j.1469-1809.1957.tb01871.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Weatherall DJ, Gilles HM, Clegg JB, Blankson JA, Mustafa D, Boi-Doku FS, Chaudhury DS. Preliminary surveys for the prevalence of the thalassemia genes in some African populations. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 1971; 65:253-65. [PMID: 4996907 DOI: 10.1080/00034983.1971.11686752] [Citation(s) in RCA: 38] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Na-Nakorn S, Wasi P. Alpha-thalassemia in Northern Thailand. Am J Hum Genet 1970; 22:645-51. [PMID: 5518459 PMCID: PMC1706656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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Weatherall DJ, Clegg JB, Blankson J, McNeil JR. A new sickling disorder resulting from interaction of the genes for haemoglobin S and alpha-thalassaemia. Br J Haematol 1969; 17:517-26. [PMID: 5357741 DOI: 10.1111/j.1365-2141.1969.tb01402.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Wasi P, Na-Nakorn S, Pootrakul S, Sookanek M, Disthasongchan P, Panich V, Pornpatkul M. Alpha- and beta-thalassemia in Thailand. Ann N Y Acad Sci 1969; 165:60-82. [PMID: 5260169 DOI: 10.1111/j.1749-6632.1969.tb27777.x] [Citation(s) in RCA: 144] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Adams HR, Wrightstone RN, Miller A, Huisman TH. Quantitation of hemoglobin alpha chains in adult and fetal goats; gene duplication and the production of polypeptide chains. Arch Biochem Biophys 1969; 132:223-36. [PMID: 5792835 DOI: 10.1016/0003-9861(69)90356-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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